Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II study

H Kuper, M Marmot, H Kuper, M Marmot

Abstract

Study objectives: To investigate the association between job strain and components of the job strain model and coronary heart disease (CHD) risk.

Design: Prospective cohort study (Whitehall II study). At the first phase of the study (1985-1988), data on self reported psychosocial work characteristics were collected from all participants. Participants were followed up until the end of phase 5 (1997-2000), with mean length of follow up of 11 years.

Setting: London based office staff in 20 civil service departments.

Participants: 6,895 male and 3,413 female civil servants aged 35-55.

Outcome measures: Incident validated CHD.

Main results: People with concurrent low decision latitude and high demands (job strain) were at the highest risk for CHD. High job demands, and, less consistently, low decision latitude, predicted CHD incidence. The effect of job strain on CHD incidence was strongest among younger workers, but there was no effect modification by social support at work, or employment grade.

Conclusions: Job strain, high job demands, and, to some extent, low decision latitude, are associated with an increased risk of CHD among British civil servants.

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